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Wisconsin’s federally facilitated exchange offers a robust number of carrier options for 2020 when compared with most other exchanges. Thirteen insurers are offering plans for 2020, albeit with localized coverage areas:

No Medicaid expansion, but also no coverage gap

Wisconsin has not accepted federal funding to expand Medicaid under the ACA, but Wisconsin Medicaid is available to adults with income up to the poverty level, so there’s no coverage gap in Wisconsin (unlike every other state that hasn’t implemented the ACA’s Medicaid expansion). U.S. Census data indicates that Wisconsin’s uninsured rate (5.5 percent in 2018) was by far the lowest of any of the states that had not expanded Medicaid at that point.

Wisconsin’s former governor, Scott Walker, took a unique approach to Medicaid in Wisconsin. The state’s BadgerCare Medicaid program used to cover people with incomes up to 200 percent of poverty, but with the availability of subsidies in the exchange starting at 100 percent of poverty, Walker cut BadgerCare eligibility down to poverty level. So now people with incomes between 100 and 200 percent of poverty instead receive subsidies to purchase plans in the exchange (they qualify for both premium subsidies and cost-sharing subsidies at that income level).

But because Wisconsin has not expanded Medicaid to 138 percent of the poverty level, the state does not receive the enhanced federal funding that the ACA provides for Medicaid expansion (in Medicaid expansion states, the federal government pays 90 percent of the cost of covering the Medicaid expansion population).

Short-term health plans in Wisconsin

Wisconsin allows short-term health plans to have a total initial duration of up to 12 months. But if the plans are renewable, the total duration, including the renewal period, can’t exceed 18 months. This is more restrictive than the federal rules implemented by the Trump administration, but state rules take precedence over federal rules in this case, so a short-term plan cannot have a duration of more than 18 months in Wisconsin.

How has Obamacare helped Wisconsin residents?

Prior to ACA implementation, U.S. Census data put Wisconsin’s uninsured rate at 9.1 percent – already significantly lower than the national average. The uninsured rate dropped to 5.7 percent by 2015, and to 5.3 percent by 2016, although it climbed slightly, to 5.5 percent, by 2018. From 2013 to 2018, the uninsured rate for the whole country fell from 14.5 percent to 8.9 percent.

Although the state has not participated in full Medicaid expansion as written in the ACA, all low- and moderate-income legal residents have access to either Medicaid or exchange subsidies; there is no coverage gap in Wisconsin.

Wisconsin and the Affordable Care Act

Wisconsin’s current Senators have both joined the Senate since 2010: Ron Johnson and Tammy Baldwin. Johnson is an ACA opponent, and brought a lawsuit against the federal government over the issue of subsidies for congress members and their staff (the suit was thrown out by a federal judge in July 2014). But Baldwin is a strong proponent of the ACA.

In the House of Representatives, representation from Wisconsin has switched to a Republican majority. As of 2020, there are four Republicans and three Democrats representing Wisconsin in the U.S. House, as well as one vacant seat.

Former governor Scott Walker opposed the Affordable Care Act, but he was defeated by Democrat Tony Evers in the 2018 election. Evers pulled Wisconsin out of the Texas v. Azar lawsuit (plaintiff states want to overturn the ACA, but Wisconsin is no longer a plaintiff state).

CHIP Wisconsin

Children’s Community Health Plan (CCHP) is an HMO owned by Children’s Hospital of Wisconsin, and is the largest BadgerCare health plan in the state. CCHP also began offering qualified health plans (QHPs, as opposed to BadgerCare/Medicaid/CHIP plans) in the Wisconsin exchange during the 2017 open enrollment period.

Does Wisconsin have a high-risk pool?

Before Obamacare brought guaranteed issue coverage to the individual health insurance market, pre-existing conditions could result in application denials, exclusions, and initial rate-ups in nearly every state, including Wisconsin. The Wisconsin Health Insurance Risk-Sharing Plan (HIRSP) was created to cover people who could not get individual health insurance because of pre-existing conditions.

Now that the ACA requires all health insurance plans to be guaranteed issue, there is no longer a need for high-risk pools. As a result, HIRSP coverage terminated on April 1, 2014, and members needed to have applied for a new, ACA-compliant plan by March 15 in order to have continuous coverage.